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Licensed Unlicensed Requires Authentication Published by De Gruyter May 1, 2006

Closing arguments for gastroschisis: management with silo reduction

  • Bill Chiu , John Lopoo , J. David Hoover , P. Stephen Almond , Robert Arensman and Mary Beth Madonna

Abstract

Background: There are two approaches to close gastroschisis. Primary closure (PC) is reduction and fascial closure; silo closure (SC) places viscera in a preformed-silo and reduces the contents over time. We have shifted from PC to SC. This study compared the outcomes of these two techniques.

Methods: Records of babies with gastroschisis from 1994–2004 were reviewed. Closure type, ventilator days, days to full-feeds, hospital days, complications, and mortality were recorded.

Results: Twenty-eight patients underwent PC; 20 patients had SC. Differences in ventilator days, days to full-feeds, and hospital days were not statistically significant. Nine PC patients developed closure-related complications vs. none in SC (P<0.05). Eight PC vs. two SC patients had non-closure-related complications (P<0.05). Four PC vs. zero SC patients developed necrotizing enterocolitis (P<0.05). Five PC vs. one SC patients had ventral hernia (P<0.05). No patient died.

Conclusion: PC resulted in higher incidence of reclosure, non-closure-related complications, and necrotizing enterocolitis. Consequently, we recommend SC as the preferred treatment.

Keywords: Gastroschisis; silo
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Corresponding author: Mary Beth Madonna, MD Children's Memorial Hospital 2300 Children's Plaza, Box 63 Chicago, IL 60614 USA Tel.: +1-773-880-4422 Fax: +1-773-880-4588

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Published Online: 2006-05-01
Published in Print: 2006-05-01

©2006 by Walter de Gruyter Berlin New York

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